Pet Questionnaire | West U Vet Clinic

Pet's Name*

Owner's Name*

First

Last

What type of diet is your pet eating and how much? (Please mention all treats and table foods as well as pet food).*

How is your pet’s appetite?*

Please list all medications your pet is currently taking – including supplements, and heartworm & flea prevention.

Have you missed any months of heartworm prevention in the past year?*

Does your dog or cat board, go to the groomer, or dog parks?*

Has your pet had any vomiting or diarrhea recently?*

Any coughing or sneezing?*

What is the frequency and for how long?*

Any travel history outside of the state?*

Where?*

Is your pet microchipped?*

Does your pet have any trouble standing up or jumping (stiffness)?*

Have you noticed any lumps or bumps on your pet?*

Does your pet drink a lot of water AND urinate a lot?*

Is your pet having any accidents in the house?*

Please list any prior medical history that you feel we should know about: (illnesses, conditions, drug/vaccine allergies, or past surgeries)*

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